Ma Glenda Jatulan Ravas, NP

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

95013651 Issued in CA

Practice address

1680 E 120TH St
Los Angeles, CA 90059-3026

Phone

(424) 338-8367

NPI assigned

Jan 9, 2020

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Nurse Practitioner

Education

Other, 2019

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Community Medical Wellness Centers USAGroup PAC ID 1759665367, 30 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Community Medical Wellness Centers USA

  • Federally Qualified Health Center (FQHC)
  • Long Beach, CA
  • NPI 1235500513

  Single Specialty

  Medicare reassignment Care Compare group NPD
• Community Medical Wellness Centers USA

  • Federally Qualified Health Center (FQHC)
  • Long Beach, CA
  • NPI 1689449571
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1578528000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1578528000000",
    "number": "1770123663",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4121 COTTONWOOD CIR",
            "city": "LAKE ELSINORE",
            "state": "CA",
            "postal_code": "925302019",
            "telephone_number": "510-456-8002"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1680 E 120TH ST",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900593026",
            "telephone_number": "424-338-8367"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RAVAS",
        "first_name": "MA GLENDA",
        "middle_name": "JATULAN",
        "credential": "NP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2020-01-09",
        "last_updated": "2020-01-09",
        "certification_date": "2020-01-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Practitioner, Family",
            "state": "CA",
            "license": "95013651",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ramin Ravaei, D.M.D.
• Sasha Ravaei, PA-C
• Neel Raval, M.D.
• Samine Ravanbakhsh, M.D.
• Bahareh Ravandi, MD
• Emma Rose Ravdin
• Sigall Rave
• Erlinda G Ravela, RD,CDE
• Kimberly Ravelero
• Keeley Shea Ravellette

• Family Nurse Practitioner in Los Angeles, CA
• Providers in Los Angeles, CA by specialty
• Family Nurse Practitioner in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 9, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.